The overall goal of this study is to identify and explain systematic biases in the editorial decision-making process by examining the factors that influence editors' decisions to accept or reject articles for publication in biomedical journals. We will study editorial practices, processes, and outcomes at four major biomedical journals in the US and the UK: Journal of the American Medical Association, Annals of Internal Medicine, The Lancet, and the British Medical Journal. We will identify the factors that influence editors' decisions to publish manuscripts, and identify sources of systematic bias in the editorial review process that may result in a publication record that is not representative of the true distribution of study findings submitted to each journal. Using multiple qualitative methods, including interviews, ethnographic observation, and conversation analysis, we will address the following: Specific Aims: 1. Describe the characteristics of the editors, reviewers, authors, and articles submitted for publication; 2. Describe the editorial process whereby articles are considered, reviewed, and accepted or rejected; 3. Identify the explicit and implicit criteria used by editors and reviewers in evaluating manuscripts; 4. Describe the social interactional features of the editorial meetings as editors reach collective decisions regarding particular manuscripts; 5. Evaluate the effectiveness of the editorial decision-making process in ensuring that the true distribution of study findings submitted is represented and that important scientific results are published fairly and quickly. We hypothesize that manuscript characteristics (such as study design, originality, topic, and direction and statistical significance of the findings), author characteristics (such as institutional affiliation, funding source, and conflict of interest statement), organizational characteristics (such as number of competing papers and number of slots available in the issue of the journal, the distribution of topics in the issue), as well as the social interactional features of the editorial meeting itself (such as the initial characterization of the paper by the lead editor, strength of positive or negative assessments, and degree of conflict or disagreement) will combine to produce decisions that ultimately favor studies with statistically significant findings over those with statistically nonsignificant findings.